Factors associated with 1-year health-related quality of life after neck-specific exercise in chronic whiplash-associated disorders: an exploratory secondary analysis of a randomized controlled trial.
Anneli Peolsson, Stefan Ljunggren, Gunnel Peterson
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In 30 seconds
This exploratory secondary analysis of a prospective, assessor-blinded, multicentre randomised trial examined factors associated with health-related quality of life (HRQoL) after neck-specific exercise in 140 people with chronic whiplash-associated disorders grades 2 and 3. Participants received clinic-based exercise or internet-based exercise with four physiotherapy visits; the programmes did not differ significantly. Improvements in psychosocial measures, pain, disability and some objective measures were associated with HRQoL improvement, but most models were non-significant. At 15 months, a model linked higher baseline adverse psychosocial and disability scores, and lower dizziness, self-efficacy and neck-muscle endurance, with clinically relevant EQ-5D-3L improvement (R 2 = 0.26, Q 2 = 0.13, p < 0.01).
Key findings
- No significant differences were found between clinic-based and internet-based neck-specific exercise programmes.
- Improvements in psychosocial measures, pain, disability and several objective measures were associated with HRQoL improvement (R 2 = 0.20 to 0.27, Q2 = 0.06 to 0.12, p < 0.05 to < 0.001).
- At 15 months, baseline adverse psychosocial measures and disability, alongside lower dizziness, self-efficacy and neck-muscle endurance, were associated with clinically relevant EQ-5D-3L improvement (R 2 = 0.26, Q 2 = 0.13, p < 0.01).
Why it matters
The analysis suggests that HRQoL outcomes after neck-specific exercise may relate to a combination of psychosocial, symptom, disability and physical measures. These associations can help frame future research into which baseline characteristics and changes accompany HRQoL improvement. However, the models had weak predictive ability, so they do not establish reliable individual prognoses.
What to keep in mind
This was an exploratory secondary analysis, and the authors report weak predictive ability; most models were non-significant.